MITA Beyond MMIS Presentation

MITA Beyond MMIS

J h L MAXIMUSJohn Lau, MAXIMUS

Ron Bennett, Deloitte Consulting

Gary Garofalo, MAXIMUSGary Garofalo, MAXIMUS

Moderator: Paul Brannan Alabama MMIS CoordinatorModerator: Paul Brannan, Alabama MMIS Coordinator

Agenda

1. Background & Overview

2. The Medicaid Enterprise Technology Platform

3. Key issues & drivers for states and yvendors

4. Core Business Services

5. Dependencies

6. Promise of SOA

7 C St di7. Case Studies

- Texas Eligibility (TIERS)

- Indiana MMCS (EB)

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- Indiana MMCS (EB)

Background & Overview

1 MITA one of the most important concepts for Medicaid 1. MITA one of the most important concepts for Medicaid operations in many years

2. Has the potential to transform the administration and delivery of Medicaid services across a variety of business services

3. Generally been seen as pertaining solely to MMIS

4. Broader view of the state Medicaid Enterprise T h l i di t th t t b li it d t Technology indicates the concept cannot be limited to MMIS.

5. Our aim here is to describe how MITA affects other Medicaid Business processes in addition to MMIS and ed ca d us ess p ocesses add t o to S a dthen to describe early experiences in implementing applications in the Medicaid Enterprise Technology domain with MITA consistent, non MMIS application architectures

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architectures

The Medicaid Enterprise Technology Platform

Must be broadly conceived as including several highly Must be broadly conceived as including several highly interrelated applications in addition to MMIS

Includes: (Use dot points & definitions)Includes: (Use dot points & definitions)

•MMIS

•MMCS•MMCS

•Eligibility

•EHRs (soon)

Portals (growing)•Portals (growing)

Derivatively – Data Warehouses

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The Medicaid Enterprise Technology Platform

In the current technology environment, these applications, though highly interdependent, are very awkwardly coupled. The platforms

t l diff t th ll l ti f are not only different, they usually span several generations of technology. It is not entirely unusual to see “network model” databases in the applications for example.

MMISMMIS

EHRsEHRs MMCSMMCS

EligibilityEligibility

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Key Issues/Drivers for States and Vendors

1.1. Fundamental Business Process shifts are being demandedFundamental Business Process shifts are being demanded

22 Program and Business Rules changingProgram and Business Rules changing2.2. Program and Business Rules changingProgram and Business Rules changing

3.3. Shifting role of the Portal as part of 1 aboveShifting role of the Portal as part of 1 above

4.4. Need for states to extend functionality to a broader set of Need for states to extend functionality to a broader set of agents and partnersagents and partnersagents and partnersagents and partners

5.5. S/W components must be engineered to adapt to evolving S/W components must be engineered to adapt to evolving sets of agency goalssets of agency goals

6.6. Need to incorporate new technologies and more COTS Need to incorporate new technologies and more COTS productsproducts

7.7. Business Process Management must be engineered into the Business Process Management must be engineered into the solutionssolutions

88 C !C !8.8. Costs!Costs!

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Core Business Services

MMISMMIS MMCSMMCS EligibilityEligibility EHRsEHRsMMISMMIS MMCSMMCS EligibilityEligibilitySystemsSystems

EHRsEHRs

MailhouseMailhouse

Document Document ManagementManagement

MailhouseMailhouse


MailhouseMailhouse


MailhouseMailhouse

Document Document ManagementManagementManagementManagement

Imaging & Content Imaging & Content ManagementManagement

Contact CenterContact Center

Web PortalWeb Portal

D t E tD t E t

ManagementManagement











File TransfersFile Transfers

SecuritySecurityData EntryData Entry


SecuritySecurity

Recipient Recipient ManagementManagement

Data EntryData Entry


SecuritySecurity


Data EntryData Entry


SecuritySecurity



Plan & Provider Plan & Provider ManagementManagement

Provider Provider ManagementManagement

Plan & Provider Plan & Provider ManagementManagement

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Dependencies

Interfaces

DB 3

Interfaces

DB 1

MMISMMIS MMCSMMCS

ApplicationsDatabases

EligibilityEligibilityEHRsEHRs

DB 2DB 4

8 of 13The way it is…The way it is…

The Promise of SOA

FormsForms

MgmtMgmt

Technical ServicesTechnical Services

HubHub

ServiceService

EDIEDI

GatewayGateway

RulesRules

EngineEngine

WorkflowWorkflow

MgmtMgmt

MITA Enterprise Service BusMITA Enterprise Service Bus

ProcessProcess EnrollEnroll EnrollEnroll DetDet MedicalMedical

AccessAccess

ServicesServices

MgmtMgmt ServiceService GatewayGateway EngineEngine MgmtMgmt

DatabaseDatabaseDBDB

MgmtMgmt

ProcessProcess

ClaimClaim

EnrollEnroll

ProviderProvider

EnrollEnroll

RecipientRecipient

DetDet

EligibilityEligibility

MedicalMedical

HistoryHistory

Business Business ServicesServices

The way it should be…The way it should be…

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Case Studies

-Texas Eligibility (TIERS) – Ron Bennett, Deloitte

-Indiana MMCS (EB) – Gary Garofalo, MAXIMUS

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Texas Eligibility (TIERS)


Moderator: Paul Brannan Alabama MMIS Coordinator

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Moderator: Paul Brannan, Alabama MMIS Coordinator

Texas Integrated Eligibility History

2000 – 2003 TIERS Texas Works • Integrate Cases/Programs2000 – 2003 TIERS Texas Works • Integrate Cases/Programs

• Medicaid Cascade2003 – 2004 TIERS LTC

2004 – 2005

HB 2292 Reorganization • Multi-Channel Access

• Privatization Analysis

h lCall Center Business Case2004 2005 • SOA Technologies, IBM

Stack, TIERS IntegrationIE Pilot

2006 – 2007 IEES Pilot • BPO Pilot

ICE / HOP / HAND • Service Enablement

2007 – 2009 • Service ReuseEnd State

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Texas Health and Human Services Commission Goals

Data Collection From: Clients through Self Service Kiosks and Internet ApplicationData Collection From: Clients through Self Service Kiosks and Internet Application

Community-based Organizations (e.g., Food Bank, Hospital, Faith-based)

Optical Technologies for Imaged Documents and FAX

Work Flow Automation Across: P S t W k

Outsourced Business Operations

Internal HHSC Employees

Work Flow Automation Across: Programs Systems Workers

Food Stamps Eligibility TX Works

TANF Document Management

MEPD

Integrate Communication Channels:

Medicaid Enrollment Vendor

Web Self Service Interactive Voice Response (IVR)

211 Call Center Document Imaging and FAX

Web services open TIERS data collection and its eligibility engine to organizations that facilitate HHSC clients obtaining benefits

while

211 Call Center Document Imaging and FAX

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whileintegrating the tools that automate eligibility/enrollment processes

for more effective and efficient program administration.

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Business ArchitectureBusiness Process

BusinessBusiness Process


Business1Business Process



Business1

Business Capabilities

Trigger Business Logic Result

Business CapabilitiesBusiness Capabilities

Trigger Business Logic ResultTrigger Business Logic Result M

aturityM

aturity

2

3

4Business Capabilities

Trigger Business Logic Result

Business CapabilitiesBusiness Capabilities

Trigger Business Logic ResultTrigger Business Logic Result M

aturity

2

3

4

Target Process Maturity

Model Process StepsBusiness Capabilities

1 2 3 4 5


1 2 3 4 5


1 2 3 4 51 2 3 4 5 5


1 2 3 4 5


1 2 3 4 5


1 2 3 4 51 2 3 4 5 5Define Triggers, Logic & Results

Relate to Process Capabilities

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Information Architecture

Examine MITA Taxonomyy

Extend to Eligibility

Define Schemas

Data In Motion

Data at Rest

Determine Information Exchange Methods

Define Data Access Services

Inquiry

CRUD

Analytical

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Analytical

Technical ArchitectureChannel Integration – Internet, Phone, Document, FAX, B2G/G2G

Global Process Engine – Orchestration and Human Task Management

Data Integration Services – Enterprise Service Bus (ESB)

Data Transformation Services

E t t/T f /L d (ETL)Extract/Transform/Load (ETL)

Unstructured Document Capture

Decision Support Services – Analytical Data Mart

Composite Services – Inquiry and CaptureComposite Services Inquiry and Capture

Eligibility Services – Business Rules Engine and Policy Decision Tables

Process Integration Services

Communication Services

Inquiry Service

Process Integration Services


Inquiry Service

AdapterData Integration Services

Adapter


Eligibility Service

Capture Service

AdapterData Integration Services

Adapter


Eligibility Service

Capture Service

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Common ServicesService

Common ServicesService

Enhanced Eligibility Services VisionSelf

Service IVR FAX/MailTrading Partners

Face to CallFace toFace

CallCenter

Apply Collect EDBC Certify Issue Notify

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Indiana MMCS (EB)

G G f l MAXIMUSGary Garofalo, MAXIMUS

Moderator: Paul Brannan Alabama MMIS Coordinator

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Moderator: Paul Brannan, Alabama MMIS Coordinator

Indiana Enrollment Broker Project Overview

O h

SERVICEHEALTH CARE

PROGRAM

HoosierKnowledge

TECHNOLOGY

Outreach

and Education

Hoosier

Healthwise

g

Management

Telephony

HelplineCare

SelectEDI

Enrollment

Healthy

Indiana

Pl

Enrollment

Broker

Applications

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Plan

Project Goals

B i G l• Business Goals

1. Maximize health plan choice selection to accommodate needs of individual members and their families

2 Maximize enrollment into managed care health programs to provide families 2. Maximize enrollment into managed care health programs to provide families and their members quality health care at a more affordable cost

3. Facilitate better quality care and increased knowledge to promote choice and independence for beneficiaries

• Technology Goals

1. Facilitate information sharing for the best customer experience

2 R d d i i i h d h h i l ffi i i2. Reduce administrative overhead through operational efficiencies

3. Provide consumers with easy access through multiple touch points

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Implementation Challenges

1. Tight timelines

2. Multiple program implementations including 1 new program

3 L i t i t ti3. Legacy environment integration

4. Reports

5. Data conversion

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Approach

• Use an MMCS SOA product to

– Reduce cost of implementation through modular design and reusable components

– Increase interoperability through standardized interfaces

– Provide greater configurability of the application

– Support greater use of commercial off-the-shelf products

– Reduce maintenance costs through Simpler Maintenance footprint

• Leverage standards to

– Promote secure data exchange

– Promote efficient data sharing

• Maximize use of beneficiary centric applications

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Business Architecture

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Technical Architecture

Plan/ProviderRecipientEnrollment

Workflow

Management

Plan/Provider

Management

Recipient

Management

Correspondence

Management

Rules/Decision

Engine

Data

Security

Enrollment

Management

IVR Management Management Engine SecurityIVR

Outbound service bus

Document

Dialerservice bus

Database

ManagementEDI

Knowledge

Management

Management

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Data Marts/

Warehouse

Future Enhancements

• New Programs - Focus on enrolling new populations into managed care

• Extend self service – Leverage online services and telephony component integration as implemented in other statesintegration as implemented in other states

• Further streamline EDI – Leverage COTS gateway software for improved security

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John Lau, MAXIMUS

11419 Sunset Hills Road

Reston, VA 20190

(703) 251-8610

JohnLau@Maximus com


400 W 15th Street Suite 1700

[email protected]

Austin, TX 78701

(512) 226-4121

[email protected]

Gary Garofalo, MAXIMUS

11419 Sunset Hills Road

Reston, VA 20190

(703) 251-8465

[email protected]

MITA Beyond MMIS Presentation

Technology

Transcript of MITA Beyond MMIS Presentation